Urinary track infection

CEBU, Philippines - Urinary tract infections are a common health problem affecting millions of people each year. Women are said to be especially prone to UTIs and that one woman in five develops a UTI during her lifetime.

UTIs in men are not so common, but they can be very serious when they do occur.

So how does an infection start?

Through the advocacy materials provided by the REDCOP (Renal Disease Control Program) at the Center for Health Promotion-Department of Health in Central Visayas, it was learned that the urinary tract can be infected from above (by bacteria entering the kidneys from the bloodstream and travelling downward) or from below (by bacteria entering the urethra and travelling upward).

The training module reads that “infection from above is most often seen in newborns with generalized infection or “sepsis” and that if there are many bacteria in the bloodstream, some are likely to get through the filters of the kidney to the urine. This is especially likely if the filters are immature, or if there are a lot of bacteria.”

In older children and adults, infection most often starts from below. In small children still using diapers, stool (which is largely bacteria) can sit for some time right at the meatus or vaginal area. “The longer it sits there, the more likely it is that bacteria may enter the urethra,” it added. “Baby boys are less likely to have this occurrence than baby girls since girls’ urethra is so much shorter while the head of the penis isn’t as likely to sit on stool.”

In addition, it was learned that older girls may become prone to UTIs through wiping back-to-front when they are first toilet-trained which pulls stool into the vaginal/meatal area. Sexually active teenage and adult women are more prone to UTIs because of friction at the meatus that tends to push bacteria into the urethra. The same mechanism may cause UTIs in teenage boys and adult men, although they are again less prone to UTIs than women of the same age.

On the question “Who are at risk for UTI?” REDCOP said that some people are more prone to getting UTI than others. “Any abnormality of the urinary tract that obstructs the flow of urine (a kidney stone, for example) sets the stage for an infection and that an enlarged prostate gland also can slow the flow of urine, thus raising the risk of infection,” the program’s statement read.

A common source of infection is catheters, or tubes, placed in the bladder. A person who cannot void or who is unconscious or critically ill often needs a catheter that stays in place for a long time. Some people, especially the elderly or those with nervous system disorders who lose bladder control, may need a catheter for life. “Bacteria on the catheter can infect the bladder, so hospital personnel take special care to keep the catheter sterile and remove it as soon as possible,” REDCOP further said.

People with diabetes have a higher risk of a UTI because of changes in the immune system. Any disorder that suppresses the immune system raises the risk of a urinary infection.

Further, UTIs may occur in infants who are born with abnormalities of the urinary tract which sometimes need to be corrected with surgery. “UTIs are rarely seen in boys and young men. One factor may be that a woman’s urethra is short, allowing bacteria quick access to the bladder.

“Also, a woman’s urethral opening is near sources of bacteria from the anus and vagina. For many women, sexual intercourse seems to trigger an infection, although the reason for this linkage is unclear.”

Pregnant women are at increased risk of having a bladder infection that can progress and develop into a kidney infection, this was also learned. The drainage system from the kidney to the bladder dilates during pregnancy and does not empty as rapidly. “This reduced flow of urine,” as explained by the module, “makes it easier for the bacteria to climb from the bladder to the kidney and for the infection to set in. UTIs during pregnancy may result in a smaller, premature baby.”

As for symptoms, not everyone with UTI has, but most people get at least some. These may include a frequent urge to urinate and a painful, burning feeling in the area of the bladder or urethra during urination. “It is not unusual to feel bad all over – tired, shaky, washed out – and to feel pain even when not urinating. Often women feel an uncomfortable pressure above the pubic bone, and some men experience fullness in the rectum. It is common for a person with a urinary infection to complain that despite the urge to urinate, only a small amount of urine is passed.”

The urine itself may look milky or cloudy, even reddish if blood is present. A fever may mean that the infection has reached the kidneys. Other symptoms of a kidney infection include pain in the back or side below the ribs; nausea or vomiting.

Moreover, symptoms of a urinary infection among children may be overlooked or attributed to another disorder. “A UTI should be considered when a child or infant seems irritable, is not eating normally, has an unexplained fever that does not go away, has incontinence or loose bowels, or is not thriving,” this was emphasized. “The child should be seen by a doctor if there are any questions about these symptoms, especially a change in the child’s urinary pattern.”

How is UTI diagnosed? In addition to a complete physical examination and medical history, laboratory tests on a sample of urine must be conducted. In the urinalysis test, the urine is examined for white and red blood cells and bacteria.

The module, however, mentioned that in more complicated cases, urine culture and sensitivity may be indicated. This means the bacteria are grown in a culture medium and tested against different antibiotics to see which drug best destroys the bacteria. “The reliability of the culture depends on how long the urine stands before the culture is started. Urine specimens should be submitted at once to the laboratory to prevent erroneous results,” this was emphasized. ?